Ep. 377 Management of HCC: Focus on Radiation Segmentectomy Part 1 with Dr. Juan Gimenez and Dr. Tyler Sandow
Oct 23, 2023
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Dr. Juan Gimenez and Dr. Tyler Sandow, experienced interventional radiologists, discuss the management of hepatocellular carcinoma (HCC). They cover topics such as building strong relations with transplant surgeons, working-up patients with HCC, effective interventional oncology services, and factors that guide their treatment plan using the Barcelona Clinic Liver Cancer (BCLC) staging algorithm. Stay tuned for Part 2 of this discussion.
Effective stratification of patients based on tumor stage and timely imaging are crucial for treatment planning and prioritization.
The evolution of interventional oncology, particularly the use of Y90 therapy, has improved outcomes in hepatocellular carcinoma by incorporating a multidisciplinary approach and selecting appropriate treatment modalities for each patient.
Deep dives
Stratification of Patients and Importance of Timely Imaging
The podcast discusses the stratification of patients based on tumor stage and the need for timely imaging. Patients with more advanced stage tumors are prioritized for procedures, while those with early-stage tumors can wait longer. The importance of having imaging done within 30 days is emphasized. Biopsy is generally avoided unless absolutely necessary, as the recurrence of tumors along the biopsy track can lead to the patient being dropped from the transplant list. In cases where biopsy is needed but criteria for hepatocellular carcinoma (HEC) are not met, mapping and biopsy can be done simultaneously to save patients an extra appointment and avoid delays in care.
The Evolution of Interventional Oncology and Y90
The podcast explores the evolution of interventional oncology, specifically the use of Y90 therapy. The guests, Dr. Juan Jimenez and Dr. Tyler Sandal, are interventional radiologists who discuss their experience with Y90 and its application in the treatment of hepatocellular carcinoma (HEC). They highlight the shift from resin to glass microspheres for Y90 treatment and the decision-making process for choosing the appropriate treatment modality for different patients. The podcast touches on the multi-disciplinary approach in their practice, involving hepatologists, oncologists, surgeons, and interventional radiologists to ensure the best outcomes for patients.
The Ochsner Practice and Approach to HCC Treatment
The podcast delves into the Ochsner practice and its approach to treating hepatocellular carcinoma (HCC). The use of the BCLC algorithm is emphasized, with a focus on providing the most durable outcomes for patients. The practice follows a hybrid model, involving a high volume of cases, including ablations, complex portal vein recances, tips, biliary procedures, and intra-arterial therapies. The referrals come from different specialties, including hepatology, oncology, and transplant. The podcast also highlights the importance of a well-coordinated team, comprising advanced practice providers, schedulers, radiologists, and other healthcare professionals, in ensuring efficient and effective patient care.
In this episode, host Dr. Chris Beck interviews Dr. Juan Gimenez and Dr. Tyler Sandow. Juan and Tyler are both interventional radiologists in New Orleans, Louisiana who practice at Ochsner Health System - one of the United States’ leading transplant centers. As a result, both doctors have significant experience in Y-90 radiation segmentectomy and other complex procedures for treatment of hepatocellular carcinoma (HCC).
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SHOW NOTES
Juan and Tyler start the episode by telling us about how their practice has evolved over the years, their experience on tumor boards, and advice for building strong relations with transplant surgeons. The doctors also tell us about their approach to working-up patients with HCC, the variety of treatment modalities, and overall timeline to transplant.
Next we discuss considerations for building an effective interventional oncology service. Taking full ownership at every step of the way is critical to this goal. To conclude the episode, Juan and Tyler discuss the Barcelona Clinic Liver Cancer (BCLC) staging algorithm, their research, and other factors that guide their treatment plan. Stay tuned for Part 2 of this discussion, releasing later this week!